COVID-19 and Breastfeeding

As with most things COVID-19 related, the research is still early and limited. It is vital that we begin to study and understand how this virus may affect postpartum and breastfeeding mothers. Breast milk provides a plethora of health benefits and parents need to know if that outweighs the potential risks.  Here, we breakdown what is known so far about this and similar viruses. 

Global Breastfeeding Benefits

First, lets look at how breastfeeding impacts infant health on the global scale.  This pandemic has reached nearly every corner of the world which is why experts are concerned about misinformation leading to even further reduced breastfeeding rates.  The Lancet research series on breastfeeding quantified the global economic health impact on breastfeeding and the strain on healthcare due to the infant illness and mortality. Of the estimated 130M live births per year globally, the Lancet report cites 820,000 infant deaths, of which 87% of those are under 6 months old, that could be mitigated with increased breastfeeding [1].

Research has shown that breastfeeding is one of the major interventions that effect mortality in children under the age of 5 years old. Breastfeeding reduces episodes of diarrhea and respiratory infections, decreasing hospital admissions by 50 to 70%. The Lancet research notes that a 10% increase in exclusive breastfeeding up to six months or continued breastfeeding up to one - two years would translate to an estimated $312M in healthcare savings in the United States alone. Long-term, additional breastfeeding benefits would impact treatment costs for infants and toddlers as much as $2.45B in the US [2].

COVID-19 Transmission Through Breast Milk?

This virus and similar infections have not been found in human milk as of 3/28/2020.  COVID-19 and related SARS-CoV attach the respiratory system and can be readily transmitted through respiratory droplets.  Transmission to breast tissue through the circulatory system has not been found [3]. 

Dr. Lu explains [4]: “According to existing complete data, amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six newborn babies delivered by infected mothers were tested for SARS‐CoV‐2, and all samples tested negative for the virus [5].”

Necessary Precautions

The CDC indicates that person-to-person spread occurs through respiratory droplets produced when an infected person coughs or sneezes.  Spread occurs when these droplets encounter another person’s mucous membranes (i.e. eyes, nose, mouth).  Common surfaces may harbor the virus for extended periods of time, up to several days, and infect unsuspecting victims [3]. 

Due to this, breastfeeding mothers with confirmed or suspected COVID-19 must take additional precautions to prevent the spread to her children.  Effective handwashing prior to feeding, avoiding touching your face throughout nursing, and taking precautions to ensure respiratory droplets do not reach your child are vital to protecting your little one [6].  If possible, wearing a mask while nursing is recommended.  Even a homemade mask is better than nothing. 

Similar precautions should be taken when pumping milk.  Thorough handwashing before touching pump and/or bottle parts as well as before feeding is recommended.  Also follow recommended pump cleaning procedures.  If possible, the CDC advises having a non-infected person feed expressed breast milk to the infant [6]. 

Past Research

A look at coronavirus and milk production yields a number of interesting studies.  In 1982, researchers vaccinated cows with a rotavirus-coronavirus vaccine and tested expressed milk for both rotavirus and coronavirus antibodies.  Antibody concentration was not significantly different when compared to nonvaccinated bovine [7].  If COVID-19 follows this, then the eventual vaccine may not translate to additional breastfeeding benefits.  It is of note that researchers are working on innovative vaccines which may react differently than the vaccine in this study. 

Conversely, science has shown that direct exposure to coronavirus results in antibody production that is detectable in expressed milk that translates to offspring benefits [8, 9].  This previous work indicates that mothers who contract COVID-19 may pass advantageous antibodies on to their nursing children.

 

UPDATE 3/30/2020: Statement from the International Society for Research in Human Milk & Lactation

 

"Human milk researchers around the world are working diligently to find out more about how the novel
coronavirus affects (or does not affect) breastfeeding, mothers, and infants. While we have little
scientific information right now, what we do know is that there have been some milk samples tested
which were collected from mothers with the novel coronavirus, and they have all been negative. It’s
important to note, however, that these samples were collected from very few mothers (14 total), and
some of the women were initially infected with the virus during late pregnancy – not while
breastfeeding. Clearly there is still a lot more to learn. For instance, scientists are working hard to make
sure that the tests typically used to find this virus work for milk – which is notoriously difficult to
analyze. It is also important to know that breastmilk passes antibodies to babies (which may provide
protection), but scientists don’t know when this happens for coronavirus. Researchers from around the
world are working together to answer these and other important questions related to COVID-19 and
breastfeeding.


Are you worried about breastfeeding during coronavirus? The United Nations Children’s Fund
(UNICEF), World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC),
and the American College of Obstetrics and Gynecology (ACOG) have clinical guidance for parents and
providers with questions about breastfeeding during the coronavirus pandemic. Importantly, at this
time none of these recommendations include stopping breastfeeding. If you are concerned about
breastfeeding your baby during this pandemic, your physician, lactation consultant, or baby’s
pediatrician are excellent resources."

Takeaways

Much more research is needed to better understand how COVID-19 is transmitted through all bodily fluids, including breast milk.  Current and past science has led the CDC to recommend mothers continue breastfeeding their children through and beyond this crisis.  If you have any questions about how to properly do so, feel free to submit any questions through our site or to info@freetofeed.com.

 

References

 

  1. Quigley, M. A., & Carson, C. (2016). Breastfeeding in the 21st century. The Lancet.

  2. Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., … Richter, L. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet.

  3. Jiang, F., Deng, L., Zhang, L., Cai, Y., Cheung, C. W., & Xia, Z. (2020). Review of the clinical characteristics of coronavirus disease 2019 (COVID-19). Journal of General Internal Medicine, 1-5.

  4. Lu, Q., & Shi, Y. (2020). Coronavirus disease (COVID‐19) and neonate: What neonatologist need to know. Journal of Medical Virology.

  5. Chen, H., Guo, J., Wang, C., Luo, F., Yu, X., Zhang, W., ... & Liao, J. (2020). Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet, 395(10226), 809-815.

  6. Orvos, J. M. (2020). CDC guidance on coronavirus in pregnant, breastfeeding women.

  7. Myers, L. L., & Snodgrass, D. R. (1982). Colostral and milk antibody titers in cows vaccinated with a modified live-rotavirus-coronavirus vaccine. Journal of the American Veterinary Medical Association, 181(5), 486-488.

  8. Panon, G., Tache, S., & Labie, C. (1987). Antiviral substances in raw bovine milk active against bovine rotavirus and coronavirus. Journal of food protection, 50(10), 862-866.

  9. Lanza, I., Shoup, D. I., & Saif, L. J. (1995). Lactogenic immunity and milk antibody isotypes to transmissible gastroenteritis virus in sows exposed to porcine respiratory coronavirus during pregnancy. American journal of veterinary research, 56(6), 739-748.

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